(a)This section applies to arrangements under a health benefit plan offered by a carrier or a self–funded group health insurance plan in which a capitated payment is:
(1)calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners;
(2)to cover the provision of a set of services defined in the health care practitioner’s or set of health care practitioners’ contract and rendered by the health care practitioner or set of health care practitioners; and
(3)paid periodically regardless of utilization of the services by the members or participants.
(b)Subject to the requirements of subsection (c) of this section, a health care practitioner or set of health care
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(a) This section applies to arrangements under a health benefit plan offered by a carrier or a self–funded group health insurance plan in which a capitated payment is:
(1) calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners;
(2) to cover the provision of a set of services defined in the health care practitioner’s or set of health care practitioners’ contract and rendered by the health care practitioner or set of health care practitioners; and
(3) paid periodically regardless of utilization of the services by the members or participants.
(b) Subject to the requirements of subsection (c) of this section, a health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205 of this article solely because the health care practitioner or set of health care practitioners enters into a contract with a carrier that includes capitated payments for services provided by the health care practitioner or set of health care practitioners.
(c) A health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205(c) of this article solely because the health care practitioner or set of health care practitioners enters into a contract with an administrator that includes capitated payments for services provided by the health care practitioner or set of health care practitioners to members of a self–funded group health plan if:
(1) the health care practitioner or set of health care practitioners participates in the administrator’s network and accepts capitated payments;
(2) the self–funded group health plan retains the obligation to provide access to covered health care benefits to participants; and
(3) the contract does not include other reimbursement arrangements that are considered acts of an insurance business under § 4–205(c) of this article.
(d) Notwithstanding subsections (b) and (c) of this section, nothing in this section may be construed to:
(1) alter any requirement for a carrier or self–funded group health plan to pay a hospital or related institution the rate approved by the Health Services Cost Review Commission for hospital services; or
(2) supersede the Health Services Cost Review Commission’s jurisdiction or authority over rate review and approval for hospital services.